NEVADA MEDICAL GROUP MANAGEMENT ASSOCIATION

Referral, predetermination, authorization, precertification: What's the difference?

22 Jul 2019 10:34 AM | Cathy Herring (Administrator)

July 22, 2019

Probably one of the trickiest parts of any physician practice administratively is understanding and effectively navigating insurance prior authorization requirements. There are many rules and regulations a provider must follow based on payer guidelines.

Authorization guidelines are among some of the most murky and confusing guidelines of them all.  After 20 years of experience and many mistakes along the way I have outlined key elements of the referral, predetermination, authorization and precertification process. 

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